CPT Code and Price List

CPT Code and Price List 2018 CPT Codes Molecular Tests Next Generation Sequencing Panels (2) Sanger Sequencing (3-4) Deletion/Duplication (MLPA) (4) Methylation Analysis (4) Targeted Analysis (4) Trinucleotide Repeat Analysis (5) Uniparental Disomy (UPD) (5) Whole Exome Sequencing (5) Focused Next Generation Sequencing (5) Targeted Known Familial Change Analysis (5) Prenatal Testing (5) Biochemical Tests Metabolomic Profiling (6) Enzyme Analysis (6) Enzyme Panels (6) Mucopolysaccharide Urine Monitoring (7) Urine Screens (7) Analyte Analysis (7) Analyte Panels (7) Cytogenetic Tests Chromosome Analysis (8) Microarray (8) Array Confirmation (8) Cell Culture Only (8) FISH Analysis (9) Trisomy FISH screen (9) Oncology Tests Chromosome Analysis (10) FISH Analysis (10) Molecular Studies, Solid Tissue (10) Molecular Studies, Microarrays (11) 1

Molecular Testing Next Generation Sequencing Panels # of Genes CPT Code Price Aortic Dysfunction or Dilation and Related Disorders Panel 20 Genes 81410 $3,000 Arterial Hypertension Panel 11 Genes 81479 $3,000 Autism Panel 83 Genes 81479 $3,500 Bardet-Biedl Syndrome Panel 26 Genes 81479 $3,500 Brugada Syndrome Panel 18 Genes 81479 $3,000 Charcot-Marie-Tooth Hereditary Neuropathy Panel 54 Genes 81448 $3,500 Coffin-Siris Syndrome Panel 22 Genes 81479 $3,500 Comprehensive Cardiac Panel 108 Genes 81413 $3,500 Comprehensive Pulmonary Panel 93 Genes 81479 $3,500 Cone-Rod Dystrophy Panel 37 Genes 81479 $3,500 Congenital Contractures Panel 57 Genes 81479 $3,500 Congenital Stationary Night Blindness Panel 15 Genes 81479 $3,000 Connnective Tissue Disorders Panel 35 Genes 81479 $3,500 Cornelia de Lange Syndrome Panel 5 Genes 81479 $3,000 Craniosynostosis Panel 8 Genes 81479 $3,000 Dilated & Arrhythmogenic Cardiomyopathy Panel 51 Genes 81439 $3,500 Epilepsy/Seizure Panel 145 Genes 81479 $3,500 Hearing Loss Panel 91 Genes 81430 $3,500 Hereditary Spastic Paraplegia Panel 79 Genes 81479 $3,500 Hermansky-Pudlak Syndrome & Pulmonary Fibrosis Panel 25 Genes 81479 $3,500 Hydrops, Non-immune Panel 24 Genes 81479 $3,500 Hypertrophic Cardiomyopathy Panel 21 Genes 81439 $3,500 Leber Congenital Amaurosis Panel 24 Genes 81479 $3,500 Long QT Syndrome Panel 18 Genes 81413 $3,000 Lysosomal Storage Disorder Panel 74 Genes 81479 $3,500 Macular Degeneration Panel 24 Genes 81479 $3,500 Mitochondrial Depletion Panel 23 Genes 81479 $3,500 Neuromuscular Disorders Panel 144 Genes 81479 $3,500 Neuronal Ceroid Lipofuscinoses Panel 9 Genes 81479 $3,000 Ocular Albinism & Hermansky-Pudlak Syndrome Panel 18 Genes 81479 $3,000 Optic Atrophy and Early Glaucoma Panel 34 Genes 81479 $3,500 Overgrowth/Macrocephaly Panel 16 Genes 81479 $3,000 Peroxisomal Biogenesis Disorders Panel 11 Genes 81479 $3,000 Primary Ciliary Dyskinesia and Cystic Fibrosis Panel 42 Genes 81479 $3,500 RASopathy Panel 23 Genes 81442 $3,500 Retinitis Pigmentosa Panel 92 Genes 81434 $3,500 Rett/Angelman syndrome Panel 21 Genes 81479 $3,500 Rhabdomyolysis and Metabolic Myopathies Panel 47 Genes 81479 $3,500 Skeletal Dysplasia Panel 11 Genes 81479 $3,000 Surfactant Dysfunction and Respiratory Distress in Premature Infants Panel 8 Genes 81479 $3,000 Vascular Malformations Panel 21 Genes 81479 $3,500 X-Linked Intellectual Disability (XLID) Panel 114 Genes 81470 $3,500 2

Molecular Testing Sanger Sequencing Tests Genes CPT Code Price 3-Methylcrotonylglycinuria I MCCC1 81406 $1,000 3-Methylcrotonylglycinuria II MCCC2 81406 $1,000 Aarskog syndrome FGD1 81479 $1,500 Adrenoleukodystrophy, X-linked ABCD1 81405 $1,000 Alpha-Mannosidosis MAN2B1 81479 $1,500 Alpha-thalassemia X-Linked Intellectual Disability XLID ATR-X 81479 $1,500 Angelman syndrome UBE3A 81406 $1,500 ARX-Related Spectrum of X-Linked Intellectual Disability XLID ARX 81404 $1,000 Aspartylglucosaminuria AGA 81479 $1,000 Beckwith-Wiedemann Syndrome CDKN1C 81404 $500 Beta-mannosidosis MANBA 81479 $1,000 Biotinidase deficiency BTD 81404 $1,000 Borjeson-Forssman-Lehmann syndrome PHF6 81479 $1,000 Carnitine Palmitoyltransferase IA Deficiency CPT1A 81406 $1,500 Carnitine Palmitoyltransferase II Deficiency CPT2 81404 $1,000 CASK-related X-linked intellectual disability (XLID) CASK 81479 $1,500 CHD7-related disorders CHD7 81407 $1,500 Citrullinemia, Type 1 ASS1 81406 $1,500 Coffin-Lowry syndrome RPS6KA3 81479 $1,500 Congenital Disorder of Glycosylation 1a PMM2 81479 $1,000 Congenital Disorder of Glycosylation 1b MPI 81405 $1,000 Congenital Disorder of Glycosylation 1c ALG6 81479 $1,000 Connexin 26 GJB2 81252 $500 Copper Transport Disorders ATP7A 81479 $1,500 Cornelia de Lange syndrome NIPBL 81479 $1,500 Creatine Transporter Deficiency SLC6A8 81479 $1,500 Cystic Fibrosis CFTR 81223 $1,500 Fabry Disease GLA 81405 $1,000 FGFR2- Related disorders FGFR2 81479 $1,200 FLNA-Related Disorders FLNA 81479 $1,500 Fucosidosis FUCA1 81479 $1,000 Galactosemia GALT 81406 $1,000 Galactosialidosis CTSA 81479 $1,200 Gaucher Disease GBA 81479 $1,000 GLI3-Related Disorders GLI3 81479 $1,500 Glutaric Acidemia, Type I GCDH 81406 $1,000 Glycogen Storage Disease, Type 0 GYS2 81479 $1,200 Kabuki syndrome KMT2D 81479 $1,500 Kabuki syndrome 2 KDM6A 81479 $1,500 Krabbe Disease GALC 81406 $1,000 Marfan syndrome FBN1 81408 $1,500 Medium-chain acyl-coa dehydrogenase (MCAD) deficiency ACADM 81479 $1,000 Metachromatic Leukodystrophy ARSA 81405 $1,000 Mucolipidosis II & III Alpha/Beta GNPTAB 81479 $1,500 Mucolipidosis III Gamma GNPTG 81479 $1,000 MPS I, Hurler Syndrome IDUA 81406 $1,000 MPS II, Hunter Syndrome IDS 81405 $1,000 MPS IIIA, Sanfilippo syndrome A SGSH 81479 $1,000 MPS IIIB, Sanfilippo syndrome B NAGLU 81479 $1,200 MPS IIIC, Sanfilippo syndrome C HGSNAT 81479 $1,500 3

Molecular Testing Sanger Sequencing Tests Cont. Genes CPT Code Price MPS IIID, Sanfilippo syndrome D GNS 81479 $1,000 MPS IVA, Morquio syndrome A GALNS 81479 $1,000 MPS IVB, GM1 Gangliosidosis, Morquio syndrome B GLB1 81479 $1,200 MPS VI, Maroteaux-Lamy syndrome ARSB 81479 $800 MPS VII, Sly Syndrome GUSB 81479 $1,000 Myotubular Myopathy, X-Linked MTM1 81406 $1,500 Neuronal Ceroid Lipofuscinosis Type 1 PPT1 81479 $800 Neuronal Ceroid Lipofuscinosis Type 2 TPP1 81479 $1,000 Neuronal Ceroid Lipofuscinosis Type 3 CLN3 81479 $1,000 Niemann-Pick disease A/B SMPD1 81479 $800 Ornithine transcarbamylase deficiency OTC 81405 $1,000 Pelizaeus-Merzbacher Disease, Spastic Paraplegia PLP1 81405 $700 Phenylketonuria PAH 81406 $1,000 POLG1-related disorders POLG1 81406 $1,500 Pompe Disease, Glycogen storage disease type II GAA 81406 $1,000 Schaaf-Yang, Prader-Willi-Like Syndrome MAGEL2 81403 $350 Primary Carnitine Deficiency, systemic SLC22A5 81405 $1,000 PTEN-related disorders PTEN 81321 $1,200 PTPN11- related disorders PTPN11 81406 $1,000 Rett syndrome MECP2 81302 $900 Saethre-Chotzen syndrome TWIST 81404 $500 Sandhoff Disease HEXB 81479 $900 Short-Chain Acyl-CoA Dehydrogenase Deficiency ACADS 81405 $1,000 Sialidosis NEU1 81479 $800 Sotos syndrome NSD1 81406 $1,500 Spinal Muscular Atrophy SMN1 81405 $1,000 Succinyl CoA : 3-oxoacid CoA transferase Deficiency OXCT1 81479 $1,000 Tay Sachs Disease HEXA 81406 $1,000 TP63-related disorders TP63 81479 $1,200 Very Long Chain Fatty Acid Deficiency ACADVL 81406 $1,500 X-Linked Hydrocephalus L1CAM 81407 $1,500 X-Linked Optiz G/BBB syndrome MID1 81479 $1,200 Deletion/Duplication (MLPA) Genes CPT Code Price Beckwith-Wiedemann Syndrome (BWS) 81401 $600 Charcot-Marie-Tooth Disease Type 1A PMP22 81324 $500 Duchenne/Becker muscular Dystrophy DMD 81161 $500 MPS II, Hunter Syndrome IDS 81404 $500 Pelizaeus-Merzbacher Disease, Spastic Paraplegia PLP1 81404 $500 PTEN-Related Disorders PTEN 81323 $500 Rett Syndrome MECP2 81304 $500 Saethre-Chotzen Syndrome TWIST1 81403 $350 Sotos Syndrome NSD1 81405 $700 Spinal Muscular Atrophy SMN1/SMN2 81401 $600 Methylation Analysis CPT Code Price Angelman/Prader-Willi Syndrome : Methylation Analysis 81331 $350 Beckwith-Wiedemann Syndrome (BWS) : Methylation Specific MLPA 81401 $600 Russell-Silver syndrome (RSS) : Methylation Specific MLPA 81401 $600 4

Molecular Testing Trinucleotide Repeat Analysis Genes CPT Code Price Fragile X Syndrome FMR1 81243 $350 Myotonic Dystrophy DMPK 81401 $350 UPD CPT Code Price Russell-Silver syndrome (RSS) Chromosome 7 81402 $500 Chromosome 14 UPD Chromosome 14 81402 $500 Angelman/Prader-Willi syndrome Chromosome 15 81402 $500 Targeted Analysis Genes CPT Code Price Achondroplasia FGFR3 81403 $350 Aminoglycoside-induced hearing loss MTRNR1 81401 $350 Beare-Stevenson with cutis gyrata FGFR2 81404 $500 Connexin 26 GJB2 81253 $350 Crouzon with acanthosis nigricans FGFR3 81403 $350 Cystic Fibrosis CFTR 81221 $350 Factor V Leiden thrombophilia F5 81241 $150 FGFR2- Related disorders FGFR2 81404 $500 Hemochromatosis HFE 81256 $250 Hypochondroplasia FGFR3 81403 $350 Non-syndromic craniosynostosis (also Muenke) FGFR3 81403 $350 Prothrombin 20210A F2 81240 $150 PTEN-related disorders PTEN 81322 $350 Rett syndrome MECP2 81303 $350 Thanatophoric dyplasia type I FGFR3 81404 $500 Thanatophoric dyplasia type II FGFR3 81403 $350 Whole Exome Sequencing CPT Code Price Whole Exome Sequencing, Trio Analysis 81415 Contact Lab Whole Exome Sequencing, Singleton Analysis 81415 Contact Lab Whole Exome Sequencing Reanalysis 81417 Contact Lab Focused Next Generation Sequencing CPT Code Price Focused NGS-Panel Contact Lab $3,000 Focused NGS- Single Gene Contact Lab $1,500 Targeted Analysis of Known Familial Changes CPT Code Price Targeted Analysis : Known Familial Mutation 81403 $350 Prenatal Testing CPT Code Price Targeted analysis known familial mutation 81403 $1,000 Maternal Cell Contamination (MCC) 81265 $350 X-Inactivation Studies CPT Code Price X-Inactivation Studies 81401 $350 5

Biochemical Tests Metabolomic Profiling CPT Code Price MetaSign : Metabolomic Profiling 84999 $1,000 Enzyme Analysis Enzymes CPT Code Price α-mannosidosis α-mannosidase 82657 $200 Aspartylglucosaminuria Aspartyglucosaminidase 82657 $200 β-mannosidosis β-mannosidase 82657 $200 Biotinidase Deficiency Biotinidase 82261 $200 Fabry Disease α-galactosidase 82657 $200 Fucosidosis α-fucosidase 82657 $200 Gaucher Disease β-glucosidase 82963 $200 Gaucher Disease Chitotriosidase 82657 $200 Glycogen Storage Disease Type II, Pompe disease α-glucosidase 82657 $200 Krabbe disease Galactocerebrosidase (DBS) 82657 $200 Metachromatic Leukodystrophy Arylsulfatase A 82657 $200 MPS I, Hurler Syndrome α-iduronidase 82657 $200 MPS II, Hunter Syndrome iduronate-2-sulfatase 82657 $200 MPS IIIA, Sanfilippo syndrome A Heparan-N-sulfatase 82657 $200 MPS IIIB, Sanfilippo syndrome B N-acetyl-alpha-D-glucosaminidase 82657 $200 MPS IIIC, Sanfilippo syndrome C Acetyl CoA : glucosamine N acetyl transferase 82657 $200 MPS IIID, Sanfilippo syndrome D N-acetyl glucosamine-6-sulfatase 82657 $200 MPS IVA, Morquio syndrome A N-acetyl-galactosamine-6-sulfatase 82657 $200 MPS IVB, GM1 Gangliosidosis, Morquio syndrome B β-galactosidase 82657 $200 MPS VI, Maroteaux-Lamy syndrome Arylsulfatase B 82657 $200 MPS VII, Sly Syndrome β-glucuronidase 82657 $200 Neuronal Ceroid Lipofuscinosis 1 (CLN1) Palmitoyl-protein thioesterase 1 82657 $200 Neuronal Ceroid Lipofuscinosis 2 (CLN2) Tripeptidyl peptidase 1 82657 $200 Niemann-Pick disease A/B Acid sphingomyelinase (DBS) 82657 $200 Schindler/Kanzaki Disease N-acetyl-alpha galactosaminidase 82657 $200 Sialidosis α-neuraminidase-sialidase 82657 $200 Tay-Sachs/Sandhoff Disease β-hexosaminidase 83080 $200 Enzyme Panels Enzymes CPT Code Price Hydrops : Enzyme Panel α-neuraminidase/sialidase, β-galactosidase, β-glucosidase 82657(x4) $800 Lysosomal Storage Disease : Enzyme Panel Lysosomal Storage Disease : Enzyme Panel (DBS) Acid sphingomyelinase, α-fucosidase, α-galactosidase, α-iduronidase, α-mannosidase, Arylsulfatase A, Aspartyglucosaminidase, β-galactosidase, β-glucosidase, β-hexosaminidase, β-mannosidase, Galactocerebrosidase, N-acetyl-α-galactosaminidase α-1,4-glucosidase, α-fucosidase, α-galactosidase, α-mannosidase, Acid sphingomyelinase, Aspartyglucosaminidase, β-galactosidase, β-glucosidase, β-mannosidase, Galactocerebrosidase, N-acetyl-α-galactosaminidase, Tripeptidyl-peptidase 1 82657(x5) $1,000 82657(x4) $800 Morquio syndrome (MPS IV), types A & B : Enzyme Panel β-galactosidase, N-acetyl-galactosamine-6-sulfatase 82657(x2) $400 Mucolipidosis II/III DBS Screen, Dried Blood Spot Acid sphingomyelinase, α-iduronidase, α-mannosidase, β-glucosidase 82657(x2) $400 Mucolipidosis II/III Screen, Plasma α-fucosidase, β-glucuronidase, hexosaminidase 82657(x2) $400 Mucopolysaccharidosis (MPS) : Enzyme Panel α-iduronidase, Acetyl CoA: glucosamine N acetyl transferase, Arylsulfatase B, β-glucuronidase, Heparan-N-sulfatase, Iduronate-2-sulfatase, N-acetyl glucosamine-6-sulfatase, N-acetyl-alpha-D-glucosaminidase, N-acetyl-galactosamine-6-sulfatase 82657(x5) $1,000 6

Biochemical Tests Enzyme Panels Cont. Enzymes CPT Codes Price Mucopolysaccharidosis (MPS) : Enzyme Panel (DBS) Multiple Sulfatase Deficiency : Enzyme Panel Neurological (Sphingolipidoses) : Enzyme Panel Oligosaccharidoses : Enzyme Panel Sanfilippo Syndrome : Enzyme Panel α-iduronidase, Iduronate-2-sulfatase, N-acetyl-alpha-galactosaminidase, N-acetyl glucosamine-6-sulfatase, β-galactosidase, Arylsulfatase B, β-glucuronidase Arylsulfatase B, Iduronate-2-sulfatase, N-acetyl-galactosamine-6-sulfatase α-galactosidase, Acid sphingomyelinase, Arylsulfatase A, β-galactosidase, β-glucosidase, β-hexosaminidase, Galactocerebrosidase, Palmitoyl-protein thioesterase 2, Tripeptidyl peptidase 1 α-fucosidase, α-mannosidase, α-neuraminidase-sialidase, Aspartyglucosaminidase, β-galactosidase, β-mannosidase, N-acetyl alpha galactosaminidase Acetyl CoA: glucosamine N acetyl transferase, Heparan-N-sulfatase, N-acetyl glucosamine-6-sulfatase, N-acetyl-alpha-D-glucosaminidase 82657(x4) $800 82657(x2) $400 82657(x3) $600 82657(x3) $600 82657(x4) $800 Mucopolysaccharide Urine Monitoring CPT Code Price MPS I/II Urine Monitoring Total GAGs, DS, HS 83864(x2) $300 MPS III Urine Monitoring Total GAGs, HS 83864(x2) $300 MPS IV Urine Monitoring Total GAGs, KS, CS 83864(x2) $300 MPS VI Urine Monitoring Total GAGs, DS 83864(x2) $300 MPS VII Urine Monitoring Total GAGs, DS, CS 83864(x2) $300 Urine Screens CPT Code Price Mucopolysaccharide (MPS) Urine Analysis Total GAGs, DS, CS, KS 83864(x3) $450 Oligosaccharide Urine Analysis 84377 $250 Analyte Analysis CPT Code Price Acylcarnitine profile 82017 $200 Amino Acid Quantitative Analysis (CSF, Plasma/Serum, Urine) 82139 $270 C5-DC (glutarylcarnitine) Analysis 82017, 82570 $242 Carnitine Analysis, Total and Free (Plasma, Urine) 82379 $120 Creatine Biosynthesis Testing : Creatine//GAA (Plasma) 82540, 82542 $148 Creatine Biosynthesis Testing : Creatine/Creatinine/GAA (Urine) 82570, 82540, 82542 $190 Creatine Kinase Analysis 82550 $48 Creatine Transporter Deficiency : Creatine/Creatinine Analysis (Urine) 82570, 82540 $90 Galactose-1-Phosphate Analysis 84378 $200 Glucose tetrasaccharide Analysis, Urine 82570, 83789 $202 Homocysteine Analysis 83090 $100 Organic Acid Analysis 83919 $231 Orotic Acid Analysis 83921 $100 Sialic Acid Analysis 84275 $200 Total Glycosaminoglycans (GAGs) Analysis 83864 $150 Tryptophan Analysis 82131 $100 Analyte Panels CPT Code Price Biochemical Genetics Profile Storage Disease: Analyte Panel Includes: Acylcarnitine profile, Amino acid (plasma), Carnitine Analysis, Total and Free, and Organic Acid Analysis. Each can be ordered separately Includes: Mucopolysaccharide (MPS) Urine Analysis, Oligosaccharide Urine Analysis, and Siaclic Acid Analysis. Each can be ordered separately 82017, 82139, 82379, 83919 $821 83864(x2), 84377, 84275 $750 7

Cytogenetics Chromosome Analysis CPT Code Price Chromosome Analysis (Amniotic Fluid) Chromosome Analysis (Chorionic Villus Sampling (CVS)) 88235, 88267, 88280, 88285(x5), 88291 88235, 88267, 88280, 88285(x5), 88291 $992 $992 Chromosome Analysis (POC) 88233(x2), 88262, 88291 $1,046 Chromosome Analysis (Solid Tissue) 88233, 88262, 88291 $704 Chromosome Analysis, High Resolution (Blood) 88230, 88262, 88289, 88291 $794 Chromosome Analysis, High Resolution, Rule out mosaic (Blood) 88230, 88263, 88285(x5), 88289, 88291 $947 Chromosome Analysis, Routine (Blood) 88230, 88262, 88291 $602 Chromosome Analysis, Routine Short Study (Blood) 88230, 88261, 88291 $530 Chromosome Analysis, Routine Rule out mosaic (Blood) 88230, 88263, 88285(x5), 88291 $755 Chromosome Analysis, Rule out mosaic (Solid Tissue) 88233, 88263, 88285(x30), 88291 $1,457 Microarray CPT Code Price CytoScan Xon Microarray : Single Gene Analysis Contact Lab $700 CytoScan Xon Microarray : 2-10 Genes Contact Lab $1,200 CytoScan Xon Microarray : More than 10 Genes Contact Lab $1,950 Pregnancy Loss Microarray 81229 $1,950 Prenatal Microarray 81229 $2,450 Targeted Infertility Microarray 81405 $1,000 Whole-Genome SNP Microarray : Cytoscan Dx (FDA Cleared) Microarray 81229 $2,450 Whole-Genome SNP Microarray : Cytoscan HD Microarray 81229 $1,950 X-Chromosome High Density Microarray 81229 $1,950 Array Confirmation CPT Code Price Array Confirmation : Family Studies Contact Lab $350 Cell Culture Only CPT Code Price Cell Culture Only (Solid Tissue) 88233, 88240 $522 Cell Culture Only (Amniotic Fluid) 88235, 88240 $492 Cell Culture Only (Blood) 88230 $240 Cell Culture Only (Chorionic Villus Sampling (CVS)) 88235, 88240 $492 8

Cytogenetics FISH Analysis Chromosomal Region CPT Code Price Angelman syndrome 15q11q13 88275, 88273, 88271, 88291 $584 Cri-du-chat syndrome 5p- 88275, 88273, 88271, 88291 $584 DiGeorge/VCF 22q11.2 88275, 88273, 88271, 88291 $584 Disorders of Sexual Development includes SRY/Xcen & X/Y dual assay probes 88275(x2), 88271(x3), 88291 $934 Kallman syndrome Xp22.3 88275, 88273, 88271, 88291 $584 Miller-Dieker syndrome 17p13 88275, 88273, 88271, 88291 $584 Prader-Willi syndrome 15q11q13 88275, 88273, 88271, 88291 $584 Smith Magenis syndrome 17p11.2 88275, 88273, 88271, 88291 $584 Steroid Sulfatase Deficiency Xp22.3 88275, 88273, 88271, 88291 $584 Williams syndrome 7q11.23 88275, 88273, 88271, 88291 $584 Wolf-Hirschhorn syndrome 4p- 88275, 88273, 88271, 88291 $584 Trisomy FISH screens Chromosomes CPT Code Price Trisomy FISH screen (13,18,21,X,Y) (Blood) 13,18,21,X,Y 88230, 88275(x2), 88271(x4), 88291 $1,074 Trisomy FISH screen (13,18,21,X,Y) (Amniotic Fluid) 13,18,21,X,Y 88235, 88275, 88271(x4), 88291 $1,144 Trisomy FISH screen (13,18,21,X,Y) (Chrorionic Villus Sampling (CVS)) 13,18,21,X,Y 88235, 88275(x2), 88271(x4), 88291 $1,372 9

Oncology Chromosome Analysis CPT Code Price Chromosome Analysis : Bone Marrow 88237, 88264, 88291, 88280(x2) $890 Chromosome Analysis : Lymph Nodes 88237, 88264, 88291, 88280(x2) $890 Chromosome Analysis : Stimulated/Unstimluated 88237, 88264, 88291, 88280(x2) $890 FISH Analysis CPT Code Price Acute Promyelocytic Leukemia (APL) FISH Analysis 88275, 88271(x2), 88291 $580 Burkitt s Lymphoma FISH Analysis 88275, 88271(x2), 88291 $530 Retinoblastoma FISH Analysis 88275, 88271, 88291 $404 Chromic Lymphocytic Leukemia (CLL) Panel delp53 [ATM/p53], Trisomy 12[D13S319/LSI 13q34/CEP 12], 14q32 [IGH BA] 88275(x2), 88271(x7), 88291 $1,388 Chronic Myelocytic Leukemia (CML) Panel t99:22) [BCR/ABL/9q34] 88275, 88271(x2), 88291 $580 Chronic Myelomonocytic Leukemia (CMML) Panel 12p13[ETV6] 88275, 88271(x2), 88291 $530 Multiple Myeloma/Plasma Cell Myeloma (PCM) Panel 88275(x2), 88271(x4), 88291 $1,010 Myelodysplastic States (MDS) Panel 88275(x4), 88271(x10), 88291 $2,222 Non-Hodgkins Lymphoma (NHL) Panel 88275(x3), 88271(x9), 88291 $1,868 Pediatric Acute Lymphoblastic Leukemia (P-ALL) Panel 88275(x3), 88271(x9), 88291 $1,868 Solid Tissue Molecular Studies CPT Code Price Acute Lymphocytic Leukemia (ALL) Panel Acute Myelocytic Leukemia (AML) Panel 8q24[C-MYC BA], 9p21[CDKN2A], t(9,22) [BCR/ABL/9q34], 11q23 (MLL) [MLL], 14q32 [IGH BA] FLT3-ITD & FLT3-TKD Variant Analysis, NPM1 codon 12 Variants 88275(x4), 88271(x10), 88291 $2,222 88275(x4), 88271(x10), 88291 $2,222 Acute Myelocytic Leukemia (AML) FLT3-ITD & FLT3-TKD Variant Analysis 81245, 81246 $500 Acute Myelocytic Leukemia (AML) NPM1 codon 12 Variants 81310 $350 Brain Tumor Panel 1p/19q, CDKN2A/B, EGFR, IDH1 R132H, NEK1, NF1, PTEN, TP53 81406 $1,000 Brain Tumor : 1p/19q Co-Deletion Analysis 1p/19q 81402 $500 Brain Tumor : CDKN2A/B Deletion Analysis CDKN2A/B 81406 $1,000 Brain Tumor : EGFR Amplification Analysis EGFR 81406 $1,000 Brain Tumor : IDH1 R132H Variant Analysis IDH1 R132H 81403 $350 Brain Tumor : NEK1 Deletion Analysis NEK1 81406 $1,000 Brain Tumor : NF1 Deletion Analysis NF1 81406 $1,000 Brain Tumor : PTEN Deletion Analysis PTEN 81323 $700 Brain Tumor : TP53 Deletion Analysis TP53 81406 $1,000 Colorectal Cancer Panel KRAS, NRAS 81479 $1,000 Colorectal Cancer : KRAS Variant Analysis KRAS 81275, 81276 $350 Colorectal Cancer : NRAS Variant Analysis NRAS 81311 $350 Lung Adenocarcinoma Panel BRAF, EGFR, PTEN 81406 $1,000 Lung Adenocarcinoma : BRAF Mutation analysis (V600E) BRAF 81210 $350 Lung Adenocarcinoma : EGFR Amplification and Mutation Analysis EGFR 81406 $1,000 Lung Adenocarcinoma : EGFR Mutation Analysis EGFR 81235 $350 Lung Adenocarcinoma : PTEN Mutation Analysis PTEN 81406 $350 Melanoma Panel 81406 $1,000 Melanoma : BRAF Mutation Analysis (V600E & V600K) BRAF 81210 $350 10

Oncology Molecular Studies, Microarrays CPT Code Price Acute Lymphocytic Leukemia (ALL) Includes genomic gains, losses, and loss of heterozygosity 81406 $1,000 Acute Myelocytic Leukemia (AML) Includes genomic gains, losses, and loss of heterozygosity 81406 $1,000 Chronic Lymphocytic Leukemia (CLL) Trisomy 21, RB1 deletions, TP53 deletions, & ATM deletions 81406 $1,000 Chronic Myelocytic Leukemia (CML) Includes genomic gains, losses, and loss of heterozygosity for cytogenetically normal CML 81406 $1,000 Lipomatous Tumors Includes genomic gains, losses, and loss of heterozygosity 81406 $1,000 OncoScan Microarray Comprehensive Analysis any FFPE tumor tissue 81229 $1,950 Revised 8/24/18 11